And deeper in the same issue came a review of ‘Bed Blocking’ by ‘The Elderly’.

Well I was not comfortable with ‘loneliness’, nor with ‘cripple’; I thought we had outlawed reference to ‘bed-blocking’ some years ago and it is decades since Bernard Isaacs urged us the get rid of 'The Elderly'. (I gather he actually wrote "Let’s abolish ‘the elderly’").

‘The Elderly’ defines a group who are ‘not us’ – set apart for special treatment or with expectations that are at odds with the mainstream. They block beds, which should be (irrespective of age, gender, race, religion …. whatever) used for the proper purpose of the NHS, cure of younger people. Hence the perception that one way or another they are crippling this worthy animal (the NHS).

Really the National Health Service is here to provide an appropriate response to the health needs – often complicated by social needs – of anyone and everyone.

There is a misfit between what we are providing and what is needed. This goes across the health/social care spectrum. The problem is not with the needs – though maybe we can do something to reduce these; the problem has to be with the pattern and capacity of provision – and this we can certainly do something about.

I railed at ‘loneliness’ because it is so often equated with an older person living alone. Solution is that everyone moves back to multi-generation households or communal living. There may be advantages to such arrangements for some – but you can feel quite ill at ease cum lonely in your daughter-in-law’s kitchen, and life for children and grandchildren might be strained by the presence of a loved one of another generation and of different experience and expectations. Living with or near other older people can have its advantages, but there can be downsides.

‘Loneliness’ is not an objective state of isolation but a subjective feeling of being bereft, that the social environment is hostile and not supportive. It is very common among young people and is usually best seen as a symptom of depression or other illness rather than a social matter per se. When older people feel lonely, their reversible unmet needs are likely to be health related. They require awareness of this possibility, accurate diagnosis and tailored treatment rather than dismissal – as ‘not for us’ in this world of triage.

Focussing attention on loneliness without acknowledging its complicated aetiologies may be as misplaced and potentially dangerous as easy reference to well-being. Beneath the fluff there are hard realities which we can address to useful effect.

A Care Worker’s Diary puts our feet on the ground and hope on our hearts.